Croup

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Counseling

Croup is usually worse at night and improves over a few days. Recommended supportive care with tylenol or motrin as needed, with an emphasis on keeping your child calm and upright in a position of comfort, since crying and agitation make breathing harder. Go to the emergency department or call 911 for noisy breathing at rest, working hard to breathe, drooling or trouble swallowing, blue color, or unusual sleepiness. Return precautions given including fever, not drinking well, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Croup
• Mild croup: no stridor at rest and no retractions
• No drooling, toxic appearance, or other signs of bacterial tracheitis, epiglottitis, or retropharyngeal abscess
• Oral steroid deferred after shared decision making
• Safe for home, with family able to return if worse
• Follow up as needed for worsening or concerns

Croup is usually worse at night and improves over a few days. Recommended supportive care with tylenol or motrin as needed, with an emphasis on keeping your child calm and upright in a position of comfort, since crying and agitation make breathing harder. Go to the emergency department or call 911 for noisy breathing at rest, working hard to breathe, drooling or trouble swallowing, blue color, or unusual sleepiness. Return precautions given including fever, not drinking well, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Mild: no stridor at rest, no indrawing
Moderate: stridor at rest, mild–moderate indrawing, no desaturation
Severe: biphasic stridor, severe indrawing, agitation, desaturation
No drooling or toxic appearance (alternate diagnoses unlikely)
Dexamethasone single dose for all
Orapred (prednisolone)
Racemic epinephrine with good or little effect
Observe 2 h after epinephrine; until stridor at rest resolves (2–4 h)
Safe discharge criteria
ED or EMS or hospitalist accepted

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Position of comfort; keep calm
Return precautions (stridor at rest, distress, drooling, cyanosis, lethargy)

Used to decide, kept out of the note

X-ray rarely needed; antibiotics not effective

Return precautions in the template

fevernot drinking well

Sources

TREKK (Translating Emergency Knowledge for Kids, Canada). Croup: Bottom Line Recommendations, version 4.0
Aregbesola A et al. Glucocorticoids for croup in children. Cochrane 2023 (as summarized by TREKK and a web search)